Potential and Limitations of Neural Decompression in Extreme Lateral Interbody Fusion-A Systematic Review

Extreme lateral interbody fusion (ELIF) is a powerful tool for interbody fusion and coronal deformity correction. However, evidence regarding the success of ELIF in decompressing foraminal, lateral recess, and central canal stenosis is lacking. We performed a systematic review of current literature on the potential and limitations of ELIF to indirectly decompress neural elements.

A literature search using PubMed, Cochrane, and ScienceDirect databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Information on study design, sample size, population, procedure, number and location of involved levels, follow-up time, and complications as well as information on conflict of interest was extracted and evaluated.

We selected 20 publications including 1080 patients for review. Most publications (90%) were retrospective case series. Most frequent indications for ELIF included degenerative disc disease, spinal stenosis, spondylolisthesis, and degenerative scoliosis. Most studies revealed significant improvement in radiographic and clinical outcome after ELIF. Mean foraminal area, central canal area, and subarticular diameter increased by 31.6 mm², 28.5 mm², and 0.85 mm. ELIF successfully improved foraminal stenosis. Contradictory results were found for indirect decompression of central canal stenosis. Data on lateral recess stenosis were scarce.

Current data suggest ELIF to be an efficient technique in decompression of foraminal stenosis. Evidence on decompression of central canal or lateral recess stenosis via ELIF is low, and results are inconsistent. Most studies are limited by study design, sample size, and potential conflicts of interest.